So, I’ve been doing a LOT of researching over the past 24 hours into what the Affordable Care Act (Obamacare) did for those of us with mental illness and what the American Health Care Act (Trumpcare?) is proposing to do.

The really really short answer? The AHCA is planning to do nothing. Except rollback the protections we had under the ACA.

First, some statistics.

1 in 5 Americans will experience mental illness during any given year.

1 in 25 Americans will experience a serious Mental Illness during any given year.

Understanding of course, that all Mental Illnesses have the potential to become serious.

50.5% of adults who experience a Substance Abuse Problem also have a Mental Illness

Now, the Affordable Care Act currently has mandates in place that ALL health insurance policies, no matter if they are purchased or provided through Medicaid, must include treatment options for Mental Illness and Substance Abuse Programs. Currently, that means that about 62 million people are covered for these conditions no matter what insurance plan they have. ( U.S. Department of Health and Human Services)

That’s a lot of people. When you figure that the ACA covers about 20 million people directly, it is also helping another 40+ million just in Mental Health and Substance Abuse Programs alone.

I also know that the Affordable Care Act is not perfect, so please don’t yell at me in the comments. Thank you.

Now, the American Health Care Act:

The AHCA strips away requirements from Medicaid to cover Mental Health and Substance Abuse Programs. There will be grants, given to states who apply, for money to fund these programs. But those grants will be gone by 2026. And your state MUST apply for those funds. In my state, which did not do a Medicaid Expansion under the ACA, I have serious doubts that we will be applying for that money. If you live in a state that does have Medicaid Expansion, hopefully your chances are higher. This is absolutely a state by state thing. You must be prepared to contact your governor about applying for this grant if the AHCA passes.

What’s Medicaid Expansion you ask? Well, Medicaid used to just cover people who lived under, or just at, the poverty line. For this year those figures (up to a household of 4 people) are:

Medicaid Expansion allowed people who made up to 138% of the poverty line to still enroll in Medicaid. So, for one person, that would now be $16,642.80.

However, as I said, not all states took the Medicaid Expansion option. Whether those states will or can apply for the money to keep Mental Health and Substance Abuse Programs will remain to be seen if the AHCA becomes law.

But, regardless, the AHCA eventually looks to phase out the Medicaid Expansion altogether. Which means that a person making $15,000.00 will have to pay for their health insurance out-of-pocket. Yes, there are tax credits. But, they are not enough. Sick people and old people are going to have a very tough time. Now, another interesting fact is that non-elderly adults working with disabilities are significantly less likely to have a job that provides health insurance. So it’s a decent bet that the person making $15,000/year has a job without health benefits.

Representative Joe Kennedy (D-Mass) and Representative Peter Welch (D-VT) introduced an Amendment in committee to include mandates for Mental Health and Substance Abuse Programs, but the Amendment failed and it failed straight down party lines.

It FAILED. I can’t say this strongly enough. Failing to protect 60+ million people from ANY disease is despicable, deplorable and immoral.

The Congressional Budget Office (CBO) released their assessment of the AHCA last week. It’s going to reduce the deficit by a lot. But it’s going to do that at the expense of citizens being able to obtain healthcare. And that means us, the Mental Health Community, as well.

There are serious questions here. If you are just over the poverty line, will you be able to afford to buy health insurance WITH Mental Health and/or Substance Abuse coverage? If you are below the poverty line, will you be able to continue to get Mental Health or Substance Abuse coverage? If you happen to be the spouse of a mentally ill wife will you have to pay extra for coverage for her mental health treatment? And finally, with the AHCA doing away with employer mandates to provide insurance, will ANYONE get health insurance through their jobs anymore?

Tomorrow I will be speaking at a rally (I suspect with a healthy dose of Valium on board!!) about these issues.

The vote in the House of Representatives is Thursday. Do yourselves a favor and call your Representative today and express your thoughts on how he/she should vote.

Don’t have your Representative’s contact information. Not a problem. Click the link below and enter your zip code. If your district is very gerrymandered (like mine) you’ll need the 4 digit extension to your zip code to narrow it down.

Currently I am on Seroquel XR 300mg. I had stopped taking Seroquel at the beginning of the year because of how expensive it is and there is no generic for the XR. My health insurance has a deductible, so until I hit it, I pay cash prices. That means around $600 for a month’s worth.

Once I meet my deductible I pay 10% of what the insurance company is willing to pay. So, if the insurance company will pay $600 (which they won’t) my out of pocket per month is $60.00. AfterI meet my deductible.

I have gone back to Seroquel XR because every single thing we’ve tried since has been an epic fail.

I’m currently working off samples. I feel terrible guilt about that because they could be being used for patients with worse or no insurance, but she has a shit-ton of them. But that won’t last forever.

If you read my post earlier I mentioned that my pdoc changed my sleeping med to Belsomra. This is because Lunesta and Restoril and whatever i was on before that, are not working.

I was prescribed 10 pills, a starter dose to see if it works. I was told to go online and print out a free trial offer for the 10 pills. I did so.

Today I got the pills. If you read my post from earlier today, you may remember that I was quoted a price of $25.50ish for the 10 pills. But, I didn’t know if that was the cash price or if that was what my portion would be after insurance was applied.

That price is what I have to pay. After insurance. For 10 pills. That’s $2.50 per pill. That also means that my insurance company is ready willing and able to pay $25.00 per pill. PER PILL.

So my sleeping pills will cost around $75.00 per month using the best health insurance I have ever been lucky enough to have.

Luckily, every other medication I take (except the Seroquel XR of course) has a generic form, so it’s pretty cheap. Some of them are dirt cheap, others are just cheap when you look at what it could be. And I’m grateful for every generic I get.

I have “Save The World” complex. I will find every problem and leap over them with a single bound, sprinkling down common sense from on high, and everything will be better.

Disability was already on my list. Stigma is on my list. Now the cost of prescription meds has made it’s way to the pile of shit I haveto do something about but have no idea where to even start.

It’s getting to be quite a large pile.

Meanwhile, I sit at the foot of the pile of all the shit I can’t do anything about right now and ponder this question.

I feel crappy today. Physically and mentally. This mixed state is still holding firm which sucks. However, the crying has finally taken it’s toll on my sinuses and now the headache has arrived.

I have managed to get a few things accomplished this morning, which, quite frankly, I am rather proud of. It’s a bummer to be proud that I actually managed to empty the dishwasher, but I am. I have to be. ‘Cause right now that’s as good as I’m gonna get.

My appointment with the pdoc is in 2 weeks and we’re going to have to work on this handful of pills. Something is seriously not right. I would call to try to get an appointment sooner, but it probably won’t work.

I have to say that I feel very lucky with respect to my therapist and pdoc. I have been reading a lot of other blogs and the problems people are having getting care is atrocious. My husband has a job that offers phenomenal insurance which is probably the reason I can get such good care.

I know that a lot of people are really interested in fighting the stigma of mental illness and I think that is very important work. But I’m realizing that there is a much bigger problem, and it is the severe lack of care that the mentally ill are receiving.

We, the mentally ill, get attention one of two ways. A celebrity, who has the disease, dies. Or someone with the disease shoots up a movie theater. That’s pretty much it. The thing is, none of this leads to reform of a badly broken system. The poor and uninsured don’t get easier access to doctors and medications. A ton of research doesn’t get funded because a beloved celebrity dies. Everyone talks about “what a tragedy” and a week later everything goes back to normal.

Meanwhile, those of us who suffer day to day, out of the limelight of celebrity, fall further and further through the cracks.

I’m going to do the research when I start to feel better, whenever that will be. But for now, strictly by anecdotal evidence, I feel confidant in saying that there are not nearly enough doctors. There are not nearly enough therapists. There is not nearly enough access to medication. There are not enough hospitals. There is not enough caring.

We need doctors who give a shit. It is so hard for us to gather the strength and the courage to try to find the doctors who will be willing to see us. Then we must wait weeks and sometimes months (MONTHS?!?!?!?!) to see the doctor. And, if we are not compatible with the doctor then we have to start over.

How is this useful??????

How is this acceptable?

And does reducing stigma fix this system?

All very interesting questions and definitely something I want to look into.

Mental health blog by a service user with bipolar disorder. Winner of the Mark Hanson Awards for Digital Media at the Mind Media Awards 2013 and the Mood Disorder category in the 2012 This Week in Mentalists Awards.